Will I bald like my grandpa

/by William Rassman, M.D./0 /

My dad is 55 and is still a NW2 with good density, but unfortunately I don’t think I got his hair genes. Looking at my maternal grandfathers pictures I have a really similar hairline to him and the same big forehead. He said he didn’t start losing hair until 40 and was a nw7 around 60. However I think he started earlier than 40 he just didn’t really notice it getting bad until then. I was an NW2 at 20 and have been on fin since then (am 23 now) and am still an NW2, but my overall density has thinned a little bit. Do people usually follow an exact pattern as certain people in their family or is it sometimes a combination of multiple people?

Many men who are balding can find someone in their family line that have a balding pattern and rate of balding that they can identify with.

Is Elan Muck on finasteride?

/by William Rassman, M.D./0 /

What is the probability of shock loss when getting a transplant without fin? Are some people able to get transplants without it?

Shock loss is common when there is a lot of miniaturization. Therefore, shock loss is more common in younger men, typically under 30 or 35 depending upon what miniaturization presents.

Should I go for a hair system?

/by William Rassman, M.D./0 /
Hair systems must be attached somehow to your scalp so that they stay on. Every type of attachment (glues, clips, weaves) kill off your hair by producing traction alopecia. This is why men who start using a hair system, rarely ever get off of it. Add to that is that they are not cheep. They often run more than a good hair transplant does.

Balding like my dad? (from Reddit)

/by William Rassman, M.D./0 /

23M and am pretty happy with my hair right now and am currently on min(2x a day)+dut(3x week) and fin(4x week). But based on my family history it looks like I have a similar pattern as my pap and will be nw7 by 50/60 and probably an nw4 by 30-40. While I would be completely devastated and depressed to lose my hair right now i know baldness is my inevitable fate and I want to try and gradually shift how much importance I place on my hair. Right now I constantly obsess over it and am frequently checking this subreddit to an almost unhealthy extent. It is understandable to care a lot more right now in my early 20s, but what are some steps that you guys have taken to come to peace and acceptance with hairloss? I will continue to treat it but I want to stop being so damn obsessed with it

Ask your Dad at what age he started balding. Most Class 7 pattern men start in their early 20s so maybe you will not follow his pattern. Age related onset is also inherited but I have seen this happen when it would be inconsistent with inherited timing: See here: https://baldingblog.com/need-master-plan-think-hair-transplants-photos/

I’m 23, should I get a hair transplant?

/by William Rassman, M.D./0 /

At 23, generally you should first try drugs like minoxidil and finasteride for a year. I have seen reversal with this drugs in men of your age. You can add microneedling as well to increase the probability of getting your hair back. If you don’t respond to the drugs, then a hair transplant may be proper depending upon many factors that you and your surgeon will work out. Depending upon your hair thickness and donor density in conjunction with your end balding pattern, decisions can be make properly.  Make sure that you get a Personalized Master Plan from your doctor and an estimate of your worst case balding pattern before you get a hair transplant

Defective beard transplant

/by William Rassman, M.D./0 /

This man found that his surgeon used 3-4 hair grafts for the beard.  It is clear that there is a texture difference between his normal beard and the transplanted beard as well as skin deformities.   I wonder if it would be worth while removing each graft that has multiple hairs and corbelling and replace them with beard hair from under the chin.  You can have a test area done and see if it solves the problem to your satisfaction before rushing into a large surgical procedure.  Then, after 6 months or so, it the test area approach works, you can replace your entire beard transplant as with the test site ?

Mechanism of Male Pattern Balding?

/by William Rassman, M.D./0 /

Can you explain more in detail the actual mechanism of MPB? I know that some hair follicles are sensitive to DHT and somehow the DHT causes miniaturization, but how does this actually work?  Also, any wisdom on why some hairs develop later in life even where there were no (or not visible?) follicles. Like pubic hair and hairs on the chest and back as men age?

I am not going to write a book to answer your question but here is a quick summary:  People who have the genes for hair loss, when exposed to DHT (normal for men to have this) trigger the process called Apoptosis (the progression of cell death) for hair follicles carrying the genes. DHT works directly on the growth center in the impacted hairs. Drugs like finasteride or dutasteride block this process so it slows down the effects of the DHT and the balding that occurs.